Provider Demographics
NPI:1053137943
Name:KIWALA, FATUMA (CNA)
Entity type:Individual
Prefix:
First Name:FATUMA
Middle Name:
Last Name:KIWALA
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11713 WOODCREEK S APT E
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-7350
Mailing Address - Country:US
Mailing Address - Phone:331-230-1154
Mailing Address - Fax:
Practice Address - Street 1:11713 WOODCREEK S APT E
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-7350
Practice Address - Country:US
Practice Address - Phone:331-230-1154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILK40024093749172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver